title: Economic costs of childhood lead exposure in low- and middle-income countries.
abstract: BACKGROUND
  Children's blood lead levels have declined worldwide, especially after the removal of lead in gasoline. However, significant exposure remains, particularly in low- and middle-income countries. To date, there have been no global estimates of the costs related to lead exposure in children in developing countries.
  
  
  OBJECTIVE
  Our main aim was to estimate the economic costs attributable to childhood lead exposure in low- and middle-income countries.
  
  
  METHODS
  We developed a regression model to estimate mean blood lead levels in our population of interest, represented by each 1-year cohort of children < 5 years of age. We used an environmentally attributable fraction model to estimate lead-attributable economic costs and limited our analysis to the neurodevelopmental impacts of lead, assessed as decrements in IQ points. Our main outcome was lost lifetime economic productivity due to early childhood exposure.
  
  
  RESULTS
  We estimated a total cost of $977 billions of international dollars in low- and middle-income countries, with economic losses equal to $134.7 billion in Africa [4.03% of gross domestic product (GDP)], $142.3 billion in Latin America and the Caribbean (2.04% of GDP), and $699.9 billion in Asia (1.88% of GDP). Our sensitivity analysis indicates a total economic loss in the range of $728.6-1162.5 billion.
  
  
  CONCLUSIONS
  We estimated that, in low- and middle-income countries, the burden associated with childhood lead exposure amounts to 1.20% of world GDP in 2011. For comparison, in the United States and Europe lead-attributable economic costs have been estimated at $50.9 and $55 billion, respectively, suggesting that the largest burden of lead exposure is now borne by low- and middle-income countries.
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York, USA. teresa.attina@gmail.com
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Attina
authors.forename: Leonardo
authors.initials: L
authors.lastname: Trasande
mesh_terms: D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003906:Developing Countries / Q000706:statistics & numerical data*; D004781:Environmental Exposure / Q000009:adverse effects / Q000191:economics*; D006801:Humans; D007223:Infant; D007360:Intelligence / Q000187:drug effects*; D007361:Intelligence Tests; D007854:Lead / Q000097:blood* / Q000633:toxicity*; D018803:Models, Economic; D012044:Regression Analysis
chemical_list: D007854:Lead